October is Breast Cancer Awareness Month. Teams of survivors and their loved ones across the country are preparing for one of the largest fundraisers of the year — Relay for Life, which raises money for cancer research.

As frightening as breast cancer is, there are countless survivors. Just how did they deal with the news of their diagnosis and the consequential treatments?

And what happens if they don’t have insurance?

“Marianna,” who asked not to use her real name, felt an unusual lump in her right breast in March 2011. She had no insurance and little money, so she ignored it for a while.

Marianna went to a clinic about four months later and was scheduled for a mammogram. But she decided she better apply for Medicaid first, which she did. Then she had the mammogram, which turned up positive — for a dreaded tumor.

Marianna’s Medicaid application was denied. She said she didn’t qualify for disability because she hadn’t worked for at least the past four years and having a tumor isn’t considered a disability.

“I didn’t work because I was taking care of my mom and uncle,” the 65-year-old said.

Her sister, a nurse, suggested she go to the Leo W. Jenkins Center in Greenville. There, she was told by a social worker there is a program available through Medicaid for people who don’t have insurance. But she discovered the patient has to be diagnosed through her local health department, which she wasn’t.

“She said Social Services should have told me, but they didn’t,” Marianna said, referring to her sister.

She discussed the problem with the Department of Social Services and made an appeal, but was still denied.

“(Social Services) said you have to go to the health department first,” Marianna said. “I want to let other women know if you find a lump and don’t have insurance, they need to go to the health department first.”

Marianna said she probably racked up about $150,000 worth of debt, which she couldn’t pay. Dodging bill collectors, she lost count of exactly how much she was billed after a while. So besides undergoing months of chemotherapy, radiation and surgeries, she still faces more bills.

“If I win the lottery,” she said, “I’ll pay everybody back.”

Susan Moore, director of the Lenoir County Department of Social Services, said a number of changes have been made at the department.

“In North Carolina,” she said, “the General Assembly has chosen not to expand Medicaid under the Affordable Care Act.”

To qualify for disability, a person must be ages 19-64, pregnant or have a minor child and be totally disabled or suffering a fatal disease.

Page 2 of 4 - As of Oct. 1, Moore said, both Medicaid and food stamp case workers are using information scripts, as all of them handle clients for both programs whether or not they have been trained in both.

Evelyn Herring, Breast/Cervical Cancer Control Program coordinator at the Lenoir County Health Department, agreed that patients must be diagnosed through the health department and qualify financially to receive assistance through the BCCCP, which is state and federally funded.

Once diagnosed through a health department, the patient applies for Medicaid. Lenoir County is allotted 35 patients a year.

“I apply for the BCCCP and that pays for medical, surgery and treatment,” Herring said.

Lisa Miller is the BCCCP coordinator for Greene County, which currently serves 25 patients through the program.

She said the patient must be income-eligible. But cancer patients should not despair over money.

“They will try to find some funding for them,” Miller said about patients who don’t qualify for BCCCP. “We don’t turn anyone away here.”

A second opinion

Herring said she is a 14-year breast cancer survivor working part-time at the health department. Prior to that, she was an oncology nurse for 15 years.

“The main thing I would tell a lady with breast cancer,” she said, “when you get a diagnosis of breast cancer, it’s not a death sentence.”

Yvette Jackson, 48, of Kinston, may have felt like she had received a death sentence when she saw the look on her doctor’s face after a breast examination.

“She had this strange look on her face like something was not right,” Jackson said.

She had previously felt a knot in her left breast, but thought it was fibrocystic like her other breast.

Her gynecologist had her get a mammogram and an ultrasound — something she always got every year.

There was a tumor.

Jackson could have had a needle biopsy then, but her gynecologist had told her to come back for a follow-up. She did and was set her up with a surgeon for a biopsy in July 2012.

The doctor removed a portion of the tumor.

“He confirmed that I had breast cancer,” she said about the surgeon. “It was not a pleasant experience because he came in smiling.”

Her only option, Jackson said the doctor told her, was a mastectomy.

“The way he described it to me,” Jackson said about the doctor, “it was like a rapid growing tumor.”

In shock, Jackson got reassurance from various people she knows and prayed.

She decided not to tell her mother right away. Instead, she told her aunt, who made an appointment for her at the Cancer Centers of North Carolina in Raleigh.

Page 3 of 4 - A specialist there — Dr. Lisa Tolnitch, who founded the Pretty in Pink Foundation and performed the first lumpectomy in Raleigh in 1988 — was horrified over the fact that Jackson hadn’t gotten a needle biopsy first, Jackson said.

“On top of that,” she said, “I had staples in my breast and (Tolnitch) was furious. She told the assistant to remove the staples. She put a strip of tape on it and it healed quicker than it had with the staples.”

Jackson was also given a choice of three options. She said she decided on a lumpectomy because it’s not as invasive as a mastectomy. After more than a year of treatments, she was clear of cancer.

Fortunately, Jackson had taken out an insurance policy for cancer beforehand and also had disability insurance so she only had to pay her deductible. She used up every bit of every type of leave and vacation she had at work, but she continued to get a paycheck.

Jackson said she had many rough days, even days where she had to crawl because it hurt to walk. But she was glad she got a second opinion.

“If you are first diagnosed with cancer,” Jackson said, “do not be afraid to get a second opinion. Once you’re going through surgery, chemotherapy and all the treatments and start feeling bad, do not ever get negative, do not ever give up — not ever.”

She cautions other women going through treatments to eat nutritional foods to keep the blood count up and get a support system of family, friends, neighbors and co-workers.

Faith, support is critical

Pam Suggs, 45, of Shine in Greene County, runs a support group in the Neuse Room at Lenoir Memorial Hospital at 6:30 p.m. on the second Tuesday of each month.

She also is captain of a Greene County Relay for Life team and has supported benefit events for other cancer patients.

There are many costs that insurance may not cover, such as some prosthetics, wigs and certain medications, she said.

Suggs faced breast cancer with two small children ages 4 and 7 after being diagnosed during an annual exam.

“From two to three weeks,” she said, “you’re feeling healthy to being diagnosed with breast cancer. So it was kind of a shock.”

Suggs regularly had annual exams, or she may not have been here today, she said.

“I did self-exams,” she said, “but, obviously, not routinely enough or not as often as I should.”

With faith and support from friends and family, Suggs is a 10-year survivor.

“I give my condition and where I am today to God,” she said.

Carol Swaney, 57, thought the knot she felt on her left breast was scar tissue from surgery when her milk glands were blocked. A biopsy showed there was a stage four malignant tumor. She underwent a lumpectomy and had 12 lymph nodes removed.

Premiums are running about $200 a month through the federal health insurance exchange, she said.

Another option for people who are employed is to make an appointment at a Vocational Rehabilitation office. They have funding and their job is to get people back to work, Moore said. Those funds can only be used for expenses incurred after being accepted, she added.

A last resort for homeowners is to apply for a reverse mortgage, which will leave the settlement for the debt to their estate upon death.

Other options include the Susan G. Komen Foundation and Pretty in Pink Foundation.

Margaret Fisher can be reached at 252-559-1082 or Margaret.Fisher@Kinston.com. Follow her on Twitter @MargaretFishr.